Type Of Congenital Diaphragmatic Hernia Research Articles

Bilateral Diaphragmatic Hernia

THE ever increasing number of publications on diaphragmatic hernia is evidence that the condition is not so rare as has been thought heretofore. In the preroentgen era, a hernia of the diaphragm was seldom diagnosed as such while the patient was alive. The first two cases, which Ambroise Paré described in 1610, were found at autopsy. In 1790, two others were reported by Petit, one of eventration and one of hernia. In 1829, Curveilliers distinguished between congenital and acquired diaphragmatic hernia. The hernia may be true or false, depending upon whether or not its contents are wrapped in a peritoneal sac. Of the 635 cases gathered by Eppinger, in 1911, from the entire literature, only a few were diagnosed during the life of the patient. Gradually the roentgen examination took first place in the diagnosis. In 1924, Moore and Kirklin estimated the number of described cases at 1,200. Up to this time only 20 cases had been diagnosed at the Mayo Clinic, a number which, six years later, had increased to 110. Similar reports are made by Healy, Morrison, Akerlund, Hedblom, LeWald, and many others. While Quenu, in 1921, considered the hernia at the hiatus esophagi as extremely rare, Moore and Kirklin, Akerlund, Morrison, Ritvo and others found this to be the most common type. Other sites at which a hernia may occur are the trigonum costosternal (foramen Morgagni), the trigonum costolumbale (foramen Bockdalecki), the foramen quadrilaterum, and the foramen nervi sympatici. It is more common on the left than on the right side. Of the 635 cases reported by Eppinger, only nine were on the right side. It appears that the large bloc of the liver prevents the formation of a hernia. However, Reich, in three of his cases, has shown that parts of the liver may form the contents of a diaphragmatic hernia. More frequently, the sac of a hernia contains stomach, intestines, omentum, or a combination of these. The sac may be small and may, in certain positions of the patient, reduce itself automatically. It may be found only by placing the patient in certain positions. However, it may reach large dimensions and fill the entire side of the chest. The parasternal type of congenital diaphragmatic hernia is very rare. Woolsey found one case of hernia of the left, and Siehlmann one case of the right, foramen Morgagni. Hedblom gathered six cases. All these, as well as all cases of diaphragmatic hernia heretofore described, have been unilateral. There is no case of bilateral hernia of the diaphragm previously described in the literature. Case Report Miss McG—, aged 60 years, a business woman. Since the onset of her periods, the patient had suffered from dysmenorrhea. Up to 1912, she had never been sick or had any injury or accident, but in that year she was operated on for a huge uterine fibroid, which weighed 28 pounds. Before, and after this, she passed three examinations for life insurance.